Thoracic and Cardiothoracic Disorders

Question 1

Anterior mediastinal masses are likely to be…?

Answer 1

thyroid, lymphoma, thymoma (associated with myasthenia gravis), teratoma/germ cell tumor

Question 2

Middle mediastinal masses are likely to be…?

Answer 2

lymphoma, sarcoid, metastatis lung cancer, sarcoid

Question 3

Posterior mediastinal masses are likely to be…?

Answer 3

neurogenic tumors

Question 4

Middle aged patient, pain in midback/ulnar region refractory to NSAIDs, no cough or SOB, Horner syndrome

Answer 4

pancoast tumor (lung cancer originating from apex of lung), can invade subclavian artery, brachail plexus, and sometimes subclavian gangila

Question 5

how to diagnose pancoast tumor

Answer 5

CT chest, bronchoscopy, mediastinoscopy, and needle biopsy

Question 6

Treatment for Pancoast tumor

Answer 6

determine if there is lymphnode involvement or metastases and concurrently treat with chemoradiation…then if no signs of distant mets or local progression, surgically resect!

Question 7

young patient, nonsmoker presents with recent onset cough, SOB, and hx of hemoptysis…chest xray shows partial collapse or RUL of lung

Answer 7

bronchial adenoma (rare)

Question 8

How to treat bronchial adenoma?

Answer 8

CT, bronchoscopy, and bronchoscopic biopsy for pathology…then complete reseection of tumor with mediastinal lymph node sampling/dissection…usually curative

Question 9

65 year old man with chest pain and SOB of 3 months duration, absent breath sounds and dullness to percussion on right lung base…cxr shows opacified right lower lung field with pleural effusion…shipyward worker

Answer 9

likely pleural effusion from mesothelimoa

Question 10

How to work up pleural effusion

Answer 10

thoracentesis and pleural biopsy

Question 11

18 year old experiences sudden hest pain follwoed by SOB playing tennis, trachea shifted left and absent breath sounds on right…dx and mechanism?

Answer 11

spontaneous pneumothorax secondary to rupture of apical blebs (formed by breakdown of septae in apex oflung)…rupture will cause air to escape into pleural space, increase interpleural pressure and collapse the lungs…

Question 12

management of pneumothorax

Answer 12

chest tube with water seal!

Question 13

How to manage air leak first time and persistent

Answer 13

replace chest tube, most air leaks will resolve this way…or persistent, may need to surgically intervene with pleurodesis to prevent recurrence of pneumothorax

Question 14

Elderly lady with pneumonia recovers after a week but then notes increased chest pain, cough, recurrent fever…chest xray shows pleural effusion…diagnosis and treatment

Answer 14

empyema

treatment = intiate antibiotics (tailor based on culture and sensitivity), drain pus, and reexpand lung

Question 15

Presence of ______ is a primary indication for CABG

Answer 15

left main disease or three vessel disaese

Question 16

Viable alternative to CABG

Answer 16

percutaneous transcatheter coronary angioplasty with stent placement

Question 17

Common cause of severe mitral regurg in males younger than 50

Answer 17

myxomatous degeneration of mitral valve

Question 18

most common cause of mitral stenosis

Answer 18

rheumatic fever

Question 19

treatment for symptomatic mitral valve disase

Answer 19

repair or replacement of mitral valve
repair by excising bad parts of valve and adding annuloplasty ring…replace with prosthetic or biologic valve if repair isn’t feasible

Question 20

When do symptoms develop in most patients with aortic stenosis?

Answer 20

age 50-60, sometimes being sudden death!

as soon as symptoms start appearing, (syncope, SOB, angina)…2 year survival is low and surgery is indicated